I am the David and Joan Traitel Senior Fellow and member of the Working Group on Health Care Policy at the Hoover Institution of Stanford University. My research includes health care policy and the roles of government versus the free market in access, pricing, and quality of medical care. I served as Professor and Chief of Neuroradiology from 1998 until 2012 at Stanford University Medical Center before my appointment at Hoover.

In the wake of the Supreme Court ruling that the Affordability Care Act meets the test of constitutionality in its most significant aspect, the individual mandate, the urgency for new, truthful leadership is obvious. The law intends to transform health care toward a European-style system by shifting nearly 20 million more people into a financially unsustainable and scandalously inadequate government Medicaid insurance program; by dictating required insurance benefits and price of coverage that will cause millions to lose their insurance; and by imposing massive taxes on all Americans and penalties on private sector employers, entrepreneurs, and investors that will cost jobs and threaten innovation. At this moment, the path forward to health care excellence must be articulated in the clearest and strongest of terms, because it is now critical that the American people understand the clear choice at hand and the consequences of inaction.

US President Barack Obama walks to the Oval Office upon returning to the White House after speaking at a rally celebrating the passage and signing into law of the Patient Protection and Affordable Care Act. (Image credit: AFP/Getty Images via @daylife)

First, our leaders must clarify that the most serious problem in American’s health care is none other than cost. The next president must overtly acknowledge and protect the proven superiority of America’s medical system in unsurpassed access, exceptional disease outcomes, unrivaled choice, and world-leading innovation that are thoroughly documented in the medical literature. The next president must aggressively and rigorously denounce the false claims of the World Health Organization rankings and other misleading measures that have already been thoroughly discredited by unbiased data, and instead confirm what American citizens and most doctors intuitively understand on their own. And the public needs to understand that despite all of these facts, the ideologically aligned mainstream media has remained silent about the truth – that the ACA law fails by all estimates to reduce the costs of America’s health care. Instead of accepting the massive exaggerations of the magnitude of the uninsured population and the wholly distorted claims surrounding the cost of care for those without insurance, the next president must articulate, in no uncertain terms, that the cost of American health care excellence is the only true crisis, an unsustainable burden to the taxpayer, to employers, to the American economy.

Second, the next administration must commit to lowering costs by increasing competition and empowering American consumers, instead of by centralized edicts. Have faith in what has succeeded in America since its birth – unleashing the power of free market competition and trusting the intelligence of informed American consumers, consumers who truly know best about the value of products they purchase when they control their own money. Reforms should aggressively ease regulations on private coverage, like stripping back unwanted coverage requirements and finally removing archaic state border limits on buying insurance. And consumer-directed health plans like cheaper catastrophic insurance and health savings accounts should be promoted. These plans have been surging in popularity, quadrupling as a choice by employees over the past 5 years to 13.5 million, because such insurance is a smart financial decision – purchase lower cost coverage, while having the opportunity to accrue tax-sheltered savings. Instead of facilitating insurance that younger, healthier people would rationally choose, the Obama law threatens these plans with its new taxes, usage restrictions, actuarial requirements, and benefits decrees. Highlighting the policy misstep of the new ACA regulations is the recent projection that widespread use of such insurance could save over $50B per year.

And make no mistake, the data are clear – prices come down from competition when medical care is exposed to free market forces rather than fixed in price by government. Truth be told, health care is ultimately not very different from any other important good or service, except in one key way – it is the most personal of all products, one that certainly no freedom-loving Americans would want to receive only as filtered by government-appointed bureaucrats who limit choices, as in other societies; societies with different values and a different commitment to individualism, freedom, and excellence.

Third, the next administration must immediately repeal the ACA’s tax increases that will hurt American families, cause job losses, and punish risk-taking innovators. The ACA punishes even the average American worker with new taxes on income, investments, and the eventual payment for taxes on medical devices and drugs. The law burdens employers, reduces jobs, and causes employers to drop the health insurance benefit. According to CBO’s projections, the ACA’s new insurance mandates, taxes, and employer penalties “will reduce employment in 2021 by about 800,000 relative to what would otherwise have occurred” and that 3 to 5 million people per year could lose employer-sponsored coverage starting in 2019 because of the law.

The ACA increases taxes that threaten innovation. Beyond suffocating the health benefits from its innovations, threatening the medical technology sector is highly counter-productive economically, since the medtech industry directly accounts for over 500,000 high paying U.S. jobs and creates an additional 2.64 U.S. jobs for every medtech position – the very sort of careers our young people seek. Already, 50% of senior medtech executives in Massachusetts said in March 2012 that they would slash R&D budgets in response to the ACA, and 25% said they would cut jobs at home and outsource manufacturing.

Fourth, our next president must sincerely believe that the most vulnerable Americans, the poor and seniors, not only want, but also deserve, the choices and the excellence that privately insured Americans already have. Americans must be awakened to the unvarnished truth – that the plan to shift nearly 20 million more people to Medicaid in President Obama’s law is not only fiscally irrational but a cynical sham of the highest order. Even if states accept this, we know that millions of those patients will not even find doctors, given that nearly half of doctors already do not accept new Medicaid patients. But we also know that Medicaid insurance, with its restrictive guidelines for diagnosis and treatment, is a proven disaster, showing more deaths, longer hospitalizations, and more complications from major surgery, cancers, heart disease, transplants, etc.

The public must also be fully aware that the ACA’s draconian cuts to Medicare, including $500 billion of Medicare Advantage cuts, will imperil seniors and roll back the clock on access to medical technology and novel drugs, the keys to the last half century of medical advances. Honest, truly compassionate leadership must recognize that poor people deserve the same choices as the rich, and that seniors deserve the right to decide with their doctors how aggressively they want to pursue advanced medical care. These goals require creative reforms to government health programs, like adding the options of cash support for private insurance, and adding choices like low cost, high deductible plans with health savings accounts, insurance that is not only cheaper but where enrollees use more preventive services and wellness programs, improving health overall.

Despite the message of the left-leaning media, the choice at hand is clear: either we can empower individuals with more choices, access to information, and control of their money, introduce a bold and fiscally sound reform of the tax treatment of the health care dollar, and eliminate government barriers to increase private sector competition; or we can impose a massive tax and regulatory scheme that expands government authority and limits consumer choice, founded on distortions and false promises, all the while causing job losses and threatening the exceptionalism of American medicine. Americans now have their chance to secure the future of American health care… and honest, unambiguous leadership committed to the facts is crucial for an informed decision to be made.

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